Herniated Disc occurs when the inner jelly-like nucleus of a spinal disk ruptures through wear and tear, or due to a sudden injury. The herniated material may press on nerves that travel through the spine, causing pain, weakness or changes in sensation.
Most herniated discs heal on their own with nonsurgical treatment. Over-the-counter pain relievers and resting to reduce inflammation can help.
Symptoms
A herniated disk happens when the gel-like center of a spinal disc ruptures through a weak area in the tough outer wall, similar to the filling being squeezed out of a jelly doughnut. Herniated discs occur in the lower lumbar (back) region of the spine and often result in neck or arm pain, numbness or weakness. Disk herniations can be caused by injury, improper lifting or aging. In some cases, herniated disks develop spontaneously without any obvious cause.
A physical exam is the first step to diagnosing a herniated disk. Your doctor will ask you to lie down and lift your legs in certain positions to see if you feel any pain or discomfort. They may also order an MRI or spine CT to see the herniated portion of your spinal cord and nerve roots. These tests can show if there is any pressure on the spinal nerves from the herniated disk.
If you are having symptoms of a herniated disc, your doctor will likely prescribe rest, which can help relieve pain. They may also recommend ice and heat therapy, as well as physical therapy to help ease your pain and improve flexibility. Medications such as anti-inflammatories, analgesics and muscle relaxants can be helpful.
Most people with a herniated disk will not need surgery. However, in some cases, the doctor may decide to operate if conservative treatment options don’t help reduce or eliminate your pain and discomfort. Surgical options include epidural corticosteroid injections and herniated disc surgery.
The best way to prevent herniated disks is to protect your back from injury and strain. Practicing proper lifting techniques, not smoking and staying active are all helpful in preventing herniated discs. A herniated disk can also be prevented by eating a healthy diet and taking supplements that promote bone health.
A herniated disc is a common condition that can cause severe pain. With the right treatment, most people will recover in a few weeks or less. Over-the-counter pain medications, such as acetaminophen and NSAIDs, can be used to treat the discomfort of a herniated disk.
Diagnosis
A herniated disc is a condition in which the gel-like center of a spinal disk ruptures through a weak area in its tough outer wall, like the filling leaking out of a jelly doughnut. This puts pressure on a spinal nerve, causing pain, numbness and/or weakness in your back or legs. Herniated discs usually result from repeated stress on the spine over a period of years. Lifting something heavy or twisting in the wrong way may be the culprit, but even normal activities can cause a herniated disk if you do it often enough.
Your doctor can diagnose a herniated disc by asking you questions about your symptoms and performing a physical exam. He will want to know where the pain is located and whether it gets worse when you are active or at rest. He will also ask when you first started feeling the symptoms. He will check your range of motion in the affected area and may perform a specialized test called the straight leg raise (SLR) test, where you lie on your back and he lifts one of your legs while keeping your knee straight. If the test reproduces your pain and numbness, this is a good indication that you have a herniated disc.
Other tests that your doctor may order include X-rays, which can show the outline of your spine and help him rule out other problems, such as a fracture or tumor. You might also have a myelogram, which combines dye injected into your spinal fluid with a CT scan to locate the area of pressure on the spinal cord. You may also have an MRI, which uses radio waves and a magnetic field to create detailed images of your spinal cord and the surrounding structures, or you might be given an electromyogram, in which needle electrodes placed into your muscles send signals to a computer that measure how much electricity is being made.
Your doctor may also prescribe rest, anti-inflammatories and physical therapy to ease your pain and improve your range of motion. Many herniated discs resolve with conservative treatment. But if you continue to have pain, numbness or weakness, surgery might be necessary.
Treatment
The good news is that most (9 out of 10) herniated discs will improve without surgery. However, if left untreated, herniated disks may cause severe pain, weakness, or loss of control of the bladder and bowel. If this happens, you should consider surgical intervention.
Treatment starts with a physical exam of your back. Your doctor will look for any sore or painful areas and ask you to lift or move your legs in specific ways. This will allow them to see if the herniated disc is causing compression of the nerves. They will also take your medical history into consideration.
An MRI is usually the next step if a physical exam has not revealed any signs of herniated discs. The MRI will provide your doctor with detailed images of the spine and surrounding muscles. These will show the shape of the vertebrae and any herniated or bulging discs. The MRI will help doctors determine the best treatment options for you.
Medications are often prescribed to treat the pain and weakness associated with herniated discs. The medications that are typically prescribed include muscle relaxants and anti-inflammatory drugs. If you are not able to find relief with these medications, your doctor may recommend a more invasive option such as epidural steroid injections (ESI). ESIs involve injecting corticosteroid medication into the space around the affected nerve root in order to reduce inflammation and alleviate symptoms.
Once a diagnosis has been made, our team will work with you to develop an individualized treatment plan. Our goal is to relieve your pain and improve your function. You will likely be given a prescription for physical therapy to strengthen the back and abdominal muscles that support your spine. Your physical therapist will also teach you specific exercises that will reduce pressure on the affected nerves and help speed up recovery.
Depending on the severity of your herniated disc, you may be required to use a walker or wheelchair for the first few weeks following surgery. It is important to follow your doctor’s instructions carefully during this time and make sure to avoid bending, twisting, or lifting anything that weighs more than 10 pounds.
Prevention
Although herniated discs (also called slipped or ruptured discs) are fairly common medical problems, they can be prevented. A herniated disc occurs when the gel-like center of a spinal disk protrudes through a tear in the outer layer, or annulus, of the disc. The protruding nucleus causes pressure on spinal nerves that travel from the vertebrae down through the spine. This can result in pain, numbness or tingling in the arms or legs. Herniated discs usually occur in the lower back, but may also affect the neck or upper back.
Typically, herniated discs develop as the result of repeated small injuries that add up over time. This can cause the annulus fibers to weaken, and a sudden increase in the amount of pressure across the disc can lead to a rupture. A herniated disc can also happen from a single event, such as lifting something that puts too much pressure on the spine or from an automobile accident or sports injury.
People who have physically demanding jobs have a higher risk of herniated disks than those in sedentary occupations. The repetitive lifting, pulling, pushing, bending sideways and twisting associated with some jobs can increase the risk of herniated disks. Smoking is thought to decrease the oxygen supply to spinal discs, making them more prone to degeneration and injury.
Being overweight also increases the stress on spinal discs. Regular exercise and maintaining a healthy weight can reduce stress on the spine. Stretching exercises can also help by increasing the flexibility of the muscles in the spine and decreasing tension in tight muscles.
Avoiding exercises that require forward-leaning positions, such as squats, can help prevent herniated discs. Other exercises that can irritate herniated discs include shoulder presses, which put strain and pressure on the lumbar area, and standing hamstring straining, which places a great deal of stress on the spine.
Vacuuming the floor frequently can irritate a herniated disc, so consider using a broom or mop to clean the floors rather than a vacuum cleaner. When doing household chores, try to bend at the knees or hips, rather than at the waist, to avoid putting too much pressure on the spine.